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Hartmann Reversal: Obesity Adversely Impacts Outcome

Lin, Fu-Lin M.D.1,2; Boutros, Marylise M.D.1; Da Silva, Giovanna M. M.D.1; Weiss, Eric G. M.D.1; Lu, Xing-Rong M.D.3; Wexner, Steven D. M.D.1

Diseases of the Colon & Rectum: January 2013 - Volume 56 - Issue 1 - p 83–90
doi: 10.1097/DCR.0b013e318270a1a3
Original Contribution: Benign Colorectal Disease

BACKGROUND: Comprehensive analyses are lacking to identify predictors of postoperative complications in patients who undergo a Hartmann reversal.

OBJECTIVE: The aim of this study is to identify predictive factors for morbidity after reversal.

DESIGN: This study is a retrospective review of prospectively collected data.

SETTINGS: The study was conducted at Cleveland Clinic Florida.

PATIENTS: Consecutive patients from January 2004 to July 2011 who underwent reversal were included.

MAIN OUTCOME MEASURES: Variables pertaining to Hartmann procedure and reversal were obtained for analyses in patients with and without postoperative complications. Univariate and multivariate analyses were performed.

RESULTS: A total of 95 patients (mean age 61 years, 56% male) underwent reversal, with an overall morbidity of 46%. Patients with and without complications had similar demographics, comorbidities, diagnoses, and Hartmann procedure intraoperative findings. Patients with complications after reversal were more likely to have prophylactic ureteral stents (61% vs 41%, p < 0.05) and an open approach (91% vs 75%, p < 0.04). Complications were associated with longer hospital stay (8.8 vs 6.9 days,p < 0.006) and higher rates of reintervention (9% vs 0%, p < 0.03) and readmission (16% vs 2%, p < 0.02). Predictors of morbidity after reversal included BMI (29 vs 26 kg/m2, p < 0.04), hospital stay for Hartmann procedure (15 vs 10 days, p < 0.03), and short distal stump (50% vs 31%, p < 0.05). BMI was the only independent predictor of morbidity (p < 0.04). Obesity was associated with significantly greater overall morbidity (64% vs 40%, p < 0.04), wound infections (56% vs 31%, p < 0.04), diverting ileostomy at reversal (24% vs 13%, p < 0.05), and time between procedures (399 vs 269 days, p < 0.02).

LIMITATIONS: This study was limited by its retrospective design.

CONCLUSIONS: Hartmann reversal is associated with significant morbidity; BMI independently predicts complications. Therefore, patients who are obese should be encouraged or even potentially required to lose weight before reversal.

1 Department of Colorectal Surgery, Cleveland Clinic Florida, Weston, Florida

2 Department of Colorectal Surgery, 117th Hospital of Chinese People’s Liberation Army, Hangzhou, Zhejiang, China

3 Department of Colorectal Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, China

Funding/Support: Marylise Boutros and Giovanna da Silva received salary support from the Foundation for Surgical Fellowships.

Financial Disclosures: None reported.

Podium presentation at the meeting of The American Society of Colon and Rectal Surgeons, San Antonio, TX, June 2 to 6, 2012, and the Congress of the International Society of Colon and Rectal Surgeons, Bologna, Italy, June 24 to 26, 2012. Poster presentation at the meeting of the Association of Coloproctology of Great Britain and Ireland, Dublin, Ireland, July1 to 3, 2012.

Correspondence: Steven D. Wexner, M.D., Department of Colorectal Surgery, 2950 Cleveland Clinic Blvd, Weston, FL 33331. E-mail: wexners@ccf.org

© The ASCRS 2013